<div class="form-wrap">
    <div class="address-action-header am-cf newleft form-head">
        <h4 class="address-title">收货地址</h4>
        <i class="btn-close iconfont icon-cha"></i>
    </div>
    <div class="newconfirm-address-form">
        <form class="am-form am-form-horizontal address-add" >
            <input name="province_id" type="hidden" />
            <input name="province_name" type="hidden"/>
            <input name="city_id" type="hidden"/>
            <input name="city_name" type="hidden" />
            <input name="district_id" type="hidden"/>
            <input name="district_name" type="hidden"/>
            <div class="am-form-group">
                <label class="am-form-label">收件人</label>
                <div class="text">
                    <input type="text" placeholder="请填写姓名" name="receiver_name" />
                </div>
            </div>
            <div class="am-form-group">
                <label class="am-form-label">联系电话</label>
                <div class="text">
                    <input type="text" placeholder="请填写手机号码" name="tel"/>
                </div>
            </div>
            <div class="am-form-group">
                <label class="am-form-label">邮政编码</label>
                <div class="text">
                    <input type="text" placeholder="邮政编码" name="code" />
                </div>
            </div>
            <div class="am-form-group">
                <label class="am-form-label">选择地址</label>
                <div class="text doc-area new-area">
                    <span>请选择</span>
                    <i class="iconfont ico-right icon-youjiantou"></i>
                </div>
            </div>
            <div class="am-form-group">
                <label class="am-form-label">详细地址</label>
                <div class="text">
                    <input type="text" placeholder="请填写街道门牌" name="detailed"/>
                </div>
            </div>
            <div class="am-form-group">
                  <label class="set-default-address am-cf">
                      <div class="am-check">
                          <input type="hidden" name="is_default" class="is_default" value="2"/>
                        <span class="check-wrapper active"></span>
                    </div>
                    <div class="set">设为默认地址</div>
                </label>
            </div>
            <p><button type="submit" class="am-btn am-btn-block save-btn">保存</button></p>
        </form>
    </div>
</div>
<div class="newconfirm-region region-add">
    <div class="address-action-header am-cf">
        <h4 class="address-title">选择地址</h4>
        <i class="btn-close iconfont icon-cha"></i>
    </div>
    <div class="region-table">
        <div class="new-label" hidden  id="addressWare"> </div>
        <ul id="region-list"> </ul>
    </div>
</div>